Exemestane is a hormone therapy used to treat breast cancer in women who have gone through menopause.

HOW DOES EXEMESTANE WORK?

Hormones are substances produced naturally in the body. These act as chemical messengers and help control the activity of cells and organs. Hormone therapies interfere with the way hormones are made or formed in the body.

Many types of breast cancer depend on the hormone estrogen to grow. This type of breast is called estrogen receptor-positive (ER-positive) breast cancer.

After menopause, estrogen is no longer made in the ovaries. Instead, it's made in the fatty tissues of the body. This happens when an enzyme called aromatase changes other hormones into estrogen. Exemestane is a drug called an aromatase inhibitor. It blocks this process and reduces the amount of estrogen in the body.

WHEN IS EXEMESTANE GIVEN?

Exemestane is used to reduce the risk of breast cancer returning. It is usually taken after having had two or three years of another hormonal drug called tamoxifen.

Exemestane is also used after other hormone therapies to control breast cancer that has spread to other parts of the body (secondary breast cancer).

Your doctor or nurse will explain how long you should take exemestane.

TAKING YOUR EXEMESTANE TABLETS

Exemestane is taken once a day in tablet form. The pills are taken at the same time each day, either in the morning or at night.

There are certain important things to remember when taking the tablets.

• Do not double the dose if you forget to take one of your pills.
• Keep the pills in their original packaging at room temperature. They should be stored away from heat and direct sunlight.
• Keep them safe and out of the reach of children.
• Get a new prescription before the one you have runs out, and keep track of holidays, when pharmacies may be closed.
• Return the remaining pills to the hospital if the treatment is discontinued.
• Avoid eating grapefruit or drinking grapefruit juice.

POSSIBLE SIDE EFFECTS OF EXEMESTANE

Here, we explain the most common side effects of exemestane. You may experience some of the side effects mentioned here, though it is rare for a patient to have all of them. If you are taking other drugs, you may have certain side effects that are not listed here.

Always inform your doctor or nurse of the side effects you experience. They can prescribe drugs to help control them and can also give you advice on managing side effects.

HOT FLASHES AND SWEATING

These are common and tend to be mild, though they can vary. Hot flashes and sweating can subside after the first few months. It can help to lower your intake of nicotine, alcohol, and hot beverages containing caffeine such as tea and coffee. Dress in layers so you can remove clothing if you need to. Natural fabrics such as cotton may be most comfortable.

Tell your doctor if your hot flashes become bothersome. Low doses of certain antidepressants can help reduce hot flashes.

ACHING OR PAIN IN THE JOINTS AND MUSCLES

You may have pain or stiffness in the joints, or sometimes in your muscles. Let your doctor or nurse know if this happens. They can prescribe painkillers and give you advice. Physical activity and maintaining a healthy weight can help reduce joint pain and keep joints flexible. Tell your doctor if this does not get better.

NAUSEA, INDIGESTION, AND ABDOMINAL PAIN

Nausea is usually mild, but tell your doctor or nurse if this happens. Try to take your exemestane pills with food or at night. Letrozole can also cause indigestion or abdominal pain. Let your health professionals know if you have any of these symptoms. They can give you drugs to help.

TIREDNESS AND LACK OF ENERGY

When you start to take exemestane, you may feel tired, drowsy, or feel like you have no energy. Try to pace yourself until this improves. It is important to strike the correct balance between getting enough rest and staying physically active. Taking short walks regularly will help you feel less tired. If you feel drowsy, don't drive or use machinery.

HEADACHES

Let your doctor or nurse know if you have headaches. Normally, this can be easily controlled with over-the-counter drugs.

DIARRHEA OR CONSTIPATION

Diarrhea is normally mild. If your diarrhea doesn't get better, your doctor may prescribe drugs to help control it. Make sure you drink at least two liters of fluids each day if you have diarrhea.

Exemestane can also cause constipation. Drinking at least two liters of fluids each day will help if this is the case. Try to eat more high-fiber foods such as fruit, vegetables, and whole-grain bread and get some light exercise.

DIFFICULTY SLEEPING AND MOOD CHANGES

If you have trouble sleeping, try to take a warm bath or drink a warm milk product before going to bed. Relaxation techniques, tapes or CDs can also help. Though less common, women may feel emotionally down while taking exemestane. Let your doctor or nurse know if this happens.

SKIN RASHES

You may develop a mild skin rash. Let your doctor or nurse know if this happens. It is very important that you contact your doctor immediately if you develop a sever rash.

HAIR THINNING

Some women notice that their hair thins out while they are taking exemestane. This is normally mild. Your hair will thicken after the treatment ends.

DIZZINESS

Exemestane may cause dizziness. Tell your doctor or nurse if this is a problem.

LESS COMMON SIDE EFFECTS OF EXEMESTANE

BONE THINNING

Taking exemestane for a number of years increases the risk of bone thinning (osteoporosis). This may increase the risk of bone fractures. You will normally have a bone density scans to check on the healthiness of your bones before and during the treatment. If you are at risk of developing osteoporosis, your doctor may prescribe drugs called bisphosphonate to protect your bones. You may also be advised to take calcium and vitamin D supplements. Take regular walks, eat a healthy diet, and do not smoke.

PAIN, NUMBNESS, AND TINGLING IN THE HANDS AND FINGERS

These symptoms may be due to carpal tunnel syndrome, which is caused by pressure on a nerve in the wrist. It is more common in women who are taking exemestane. Tell your doctor if you have these symptoms.

The side effects can normally be controlled or improved. Always inform your doctor or nurse of any side effects you experience.

CHANGES IN THE LIVER

Exemestane can change the way the liver functions. It is unlikely that you will notice any problems. Your doctor will have you take periodic blood tests to check that your liver is functioning properly.

MORE INFORMATION ABOUT EXEMESTANE

IF YOU HAVE PROBLEMS

Most side effects settle down within a few months or can be controlled or managed. However, they may be more problematic for some women. If this is the case, make sure you talk to your cancer doctor or nurse. They can normally suggest ways to improve the side effects.

It is very important that you do not stop taking exemestane without telling your doctor, as this may affect the success of the treatment. It the side effects are very bothersome and are unmanageable, your oncologist may suggest you start on a different hormone therapy.

FLUID BUILD-UP

You may notice your legs and ankles become swollen because of the build-up of fluid. Let your doctor or nurse know if this happens. If your ankles and legs swell up, it may help to put your feet up on a stool or cushion. Steroids in pill form will help prevent this.

OTHER DRUGS

Exemestane can interact with other drugs. This includes medications that can be purchased in a store or pharmacy. Tell your doctor if you are taking any other medication. These include complementary therapies, vitamins, and herbal remedies.

MEDICAL OR DENTAL TREATMENT

If you have to go to the hospital for whatever reason other than cancer, always tell the doctors and nurses that you are taking exemestane. Explain that you are taking hormone therapy and that no one should start or stop it without taking to your cancer specialist in the first place.

Always let your dentist know that you are taking exemestane.